Nigerian govt puts millions of children in danger as country runs out of vaccines

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An estimated six to seven million Nigerian children of immunizable age are in danger of dying from vaccine-preventable diseases this year, if the Federal Government fails to intervene in the current stock out of vaccines in the country, a body of scientists is warning.

The impact may not be fully felt yet as some states still rely on reserves. Lagos State, for instance, says it still has a three-month supply of BCG (given at birth against tuberculosis) OPV (oral polio virus), Pentavalent combination, measles, yellow fever and tetanus toxoid vaccines).

The United Nations Children Education Funds (UNICEF) regards provision of childhood immunizations as a basic child right and that no child should be denied immunization, as it is the most significant, affordable and cost effective child survival intervention.

The Nigerian Academy of Science says for the country to be running out of vaccines is a reflection of the sheer ineptitude on the part of government

The main procurer of vaccines for the country, the National Primary Healthcare Development Agency (NPHCDA), had given enough notice in a publication it released in October 2013, stating the trend of vaccine availability. But no concrete action was taken, with the NPHDCA claiming it was awaiting release of funds to purchase vaccines.

Already, the supply of DTP vaccines (against diptheria, pertussis and whooping cough) and measles depleted this January, according to (NPHCDA). BCG and Hepatitis B vaccines will run out of stock in supply this February, while Tetanus Toxoid (TT) against tetanus will be out of stock by April vaccine. The popular OPV against poliomyelitis will stock out by April, while the combination of DPT, Hep B and Hib will end by May.

Going by WHO statistics, vaccine preventable diseases account for 40 per cent of all childhood deaths in Nigeria. Pneumonia, which is one of them, is the leading cause of death in children worldwide killing an estimated 1.1 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined. Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors. But the vaccine that could offer protection against pneumonia in children Hib, pneumococcus, measles and whooping cough (pertussis) is already out of stock!

This no doubt, spells doom for the fate of millions of children, and unquantifiable human sorrows, loss of man-hours and economic loss to homes and societies.

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Professor Oyewale Tomori, president of the Nigerian Academy of Science and also a virologist renowned to be at the frontier of immunization in the country, says vaccine stock outs is becoming unacceptably common in Nigeria and it is due to the government’s habit of cutting corners in order to make pecuniary gains at the expense of lives.

The current situation, he says, is very critical because even if funds are released now, it takes a long protocol to cash the money and make payment. Plus the fact that some of these vaccines might take up to six months after order to be delivered.

He says the immediate way out of this stock out quagmire is timely release of budget, but on the long run, Nigeria may have to return to local production as it did in the 1980s.

“We can prevent vaccine stock outs; with proper planning, timely release of funds to ensure that we have the vaccines. According to him, it is very simple if we do the right thing at the right time and estimate how much vaccines we need, calculate how long will it take to procure them.

Further expressing his displeasure in an interview with PREMIUM TIMES, he adds, “But this is one nation that complicates the simplest issues, deliberately creating chaos to override the rules and due process so that fraud can be perpetuated—making money off the dead that die from lack of vaccines!”

Local manufacture

The Federal Government spends not less than 12 billion naira yearly to purchase approximately 130 million doses of vaccines at the rate of over US$1 per dose or US$15 per child. Global Alliance for Vaccine Initiatives (GAVI), UNICEF, WHO, Bill Gates, other foreign governments – Japan, USA, UK, etc, also pitch in financial and technical support.

Not only are the vaccines imported, but its entire cold chain as well – cold room, refrigerators, deep freezers for cold boxes, syringes, needles, diluents and brought into the country from abroad too.

As the nation’s advisory organ on scientific issues, the Nigeria Academy of Science says since the country has the capability to make its own vaccine locally, it can save this huge cost.

“A nation with our resources and population can begin vaccine production within 12-18 months, starting with “packaging” of already manufactured vaccines and growing to where we can locally produce.”

In the 1980s and early 1990s, Nigeria was actually producing vaccines for human use in Yaba. The Federal Vaccine production laboratory (FVPL) in Yaba (now Biovaccine Nigeria) was producing yellow fever and smallpox vaccines. Indeed, the first batch of yellow fever vaccines used during the 1985 Yellow Fever outbreak were locally produced. Somehow, local production was abandoned for importation and it has not recovered since then.

About seven years ago, the Nigerian governmentjoined May and Baker in forming a company – the BioVaccines Limited, to produce vaccines in Nigeria, handing over the Federal vaccine lab to the new company, but the Biovaccines has not produced a single dose of vaccines since its establishment.

Implications

Nigeria is Africa’s most populous country and has the second highest child mortality rate after India. It is among the 189 signatories to the United Nations Millennium Development Goals (MDG), but its progress has been below satisfactory and this current stock out makes it even worse. “We will certainly fail to meet the MDG goals, especially MDG4, MDG 5 and may be MDG 1,” Professor Tomori says.

According to a UNICEF report on the under-fives mortality rate between 2009 and 2011, the under-fives rate has dropped by 45 per cent but this progress is not a reality for all countries as under-five mortality in Nigeria increased from 138 per 1000 in 2007 to 158 per 1000 in 2011. That means out of every 1000 children born, 158 of them will not see their fifth birthday.

For example a stock out of measles vaccines in 2013 resulted in the occurrence of 57,892 measles cases with 348 deaths. In 2012, the number of reported measles cases was 11,061, with 126 deaths. This represents more than 500 per cent increase in the number of measles cases from 2012 to 2013.

Indeed the reported number of measles cases in 2013 was the highest in the last 6 years. Most (78 per cent) of the 2013 measles cases occurred in children between the ages of 9 and 59 months. Significantly, 88 per cent of the children coming down with measles had not received a single dose of measles vaccine. With the measles vaccine stock out in 2013, our national measles coverage rate of will drop to 42 per cent, about half of the coverage rate of 80 per cent for all vaccines, recommended by WHO.

Nigeria remains one of the most entrenched reservoirs of the wild polio virus in the world. In spite of huge resources and efforts spent on routine immunizations days, the Global Polio Eradication Initiative reports that it is the only country with the ongoing transmission of all three serotypes. (The other countries are Afghanistan and Pakistan).

Succour in Lagos?

The Lagos State government, in response to this situation, is claiming it is unaffected by the vaccine scarcity.

“We have enough vaccines within the state to immunize our children. Stock out? No, not in Lagos,” Dr. Fawsat Sanni, the director of medical services at the State’s Primary Healthcare Board, told PREMIUM TIMES. She adds, “Lagos State has enough vaccines of all antigens that can last 3 months.”

It remains to be seen how long Lagos can hold out since the national body from where vaccines are obtained says it is running out of stock.

Some experts say the Federal Government should take its hand off vaccine production, hand it over to the private sector while the government strengthens its regulatory role on the activities of vaccine manufacturers.

Some mothers are apprehensive about the situation. “This is really a sad news, says Jane Aliu, nursing a 6-month-old baby who will be due for vaccination against measles at nine months (in three months).

“The government or whosoever is responsible for making immunization available should be held responsible if so many children die as a result of this negligence.”

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